Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists: Exploring Their Impact on Diabetes, Obesity, and Cardiovascular Health Through a Comprehensive Literature Review.

Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) are a novel class of medications promising for treating type 2 diabetes mellitus (T2DM) and obesity-related conditions such as cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD). This comprehensive literature review examines available research on these medications, focusing on their mechanisms of action, clinical effectiveness, safety profiles, and socioeconomic implications. A comprehensive search was performed using the PubMed, EMBASE, and Cochrane Library databases. Although initially developed for glucose management, these drugs have also demonstrated efficacy in promoting weight loss and reducing the risk of CVD. GLP-1-RAs function similarly to naturally occurring incretins. They stimulate insulin secretion in response to glucose levels, inhibit glucagon release, delay stomach emptying, and generate a sense of fullness via brain pathways. Head-to-head clinical studies have indicated that GLP-1-RAs outperform conventional antidiabetic medicines in terms of glycemic management and weight reduction. According to cardiovascular outcome studies, various drugs in this category have been found to reduce the frequency of severe adverse cardiovascular events. A common side effect is gastrointestinal toxicity, which can be mitigated by gradually increasing the dose. Personalized treatment is likely because the effectiveness, safety, and dose regimens of currently available GLP-1-RAs differ. GLP-1-RAs are a superior choice for patients with T2DM, especially those who already have CVD or require weight-control support. The high cost of these drugs creates hurdles to access and fair healthcare. Current research mainly focuses on increasing therapeutic uses and producing orally delivered medicines with greater potency and bioavailability. Integrating GLP-1-RAs into clinical practice can enhance patient outcomes and reduce the community burden of cardiometabolic disease.

Multidisciplinary Management of a Pregnant Trauma Patient With Gestational Diabetes: A Case Report on Combined Regional Anesthesia.

This clinical case report describes the management of a 36-year-old pregnant female at 36 weeks gestation, who was admitted to King Abdulaziz Medical City following a motor vehicle accident. The patient, with a history of gestational diabetes mellitus, sustained multiple fractures requiring surgical intervention. A combined spinal and supraclavicular block was chosen for anesthesia, with a contingency plan for general anesthesia and emergency cesarean section if needed. The surgical procedures were completed successfully, and the patient was stable postoperatively.

Three dimensional assessment of root changes after multi-segments Le Fort I osteotomy.

The primary purpose of this study was to accurately assess linear, volumetric and morphological changes of maxillary teeth roots following multi-segments Le Fort I osteotomy. A secondary objective was to assess whether patient- and/or treatment-related factors might influence root remodeling. A total of 60 patients (590 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The multi-segments group included 30 patients who had either 2-segments or 3-segments Le Fort I osteotomy. The other 30 patients underwent one-segment Le Fort I osteotomy. Preoperative, 1 year, and 2 years postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and fully automated method for evaluating root changes in three dimensions (3D) was applied. No statistical significant differences were found between multi-segments and one-segment Le Fort I for linear, volumetric and morphological measurements. The Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement leading to more root remodeling. This research may allow surgeons to properly assess root remodeling after combined treatment of orthodontics and the different Le Fort I osteotomies.

Convolutional neural network for automated tooth segmentation on intraoral scans.

BACKGROUND: Tooth segmentation on intraoral scanned (IOS) data is a prerequisite for clinical applications in digital workflows. Current state-of-the-art methods lack the robustness to handle variability in dental conditions. This study aims to propose and evaluate the performance of a convolutional neural network (CNN) model for automatic tooth segmentation on IOS images. METHODS: A dataset of 761 IOS images (380 upper jaws, 381 lower jaws) was acquired using an intraoral scanner. The inclusion criteria included a full set of permanent teeth, teeth with orthodontic brackets, and partially edentulous dentition. A multi-step 3D U-Net pipeline was designed for automated tooth segmentation on IOS images. The model's performance was assessed in terms of time and accuracy. Additionally, the model was deployed on an online cloud-based platform, where a separate subsample of 18 IOS images was used to test the clinical applicability of the model by comparing three modes of segmentation: automated artificial intelligence-driven (A-AI), refined (R-AI), and semi-automatic (SA) segmentation. RESULTS: The average time for automated segmentation was 31.7 ± 8.1 s per jaw. The CNN model achieved an Intersection over Union (IoU) score of 91%, with the full set of teeth achieving the highest performance and the partially edentulous group scoring the lowest. In terms of clinical applicability, SA took an average of 860.4 s per case, whereas R-AI showed a 2.6-fold decrease in time (328.5 s). Furthermore, R-AI offered higher performance and reliability compared to SA, regardless of the dentition group. CONCLUSIONS: The 3D U-Net pipeline was accurate, efficient, and consistent for automatic tooth segmentation on IOS images. The online cloud-based platform could serve as a viable alternative for IOS segmentation.

New Trends of Warthin Tumor Management: A Systematic Review of Nonsurgical Modalities.

Objective: To provide a comprehensive review of nonsurgical approaches for the management of Warthin's tumors (WTs) and evaluate their safety and efficacy as alternatives to surgical intervention. Methods: A systematic literature search was conducted in PubMed, Web of Science, Cochrane Library, and Embase databases using specific keywords related to WT and nonsurgical treatments. Studies published before 2012, non-English publications, and mixed methodology articles were excluded. The selection process involved title and abstract screening, followed by a thorough assessment of the remaining articles based on inclusion and exclusion criteria. Data regarding study characteristics, participants, interventions, and outcomes were collected. Results: A total of 1582 records were analyzed, and 6 studies met the inclusion criteria. These studies evaluated different nonsurgical interventions for WT management, including microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy. The findings demonstrated that microwave ablation and radiofrequency ablation led to a significant reduction in tumor size and improved cosmetic appearance. Ultrasound-guided ethanol sclerotherapy also resulted in a notable decrease in tumor size without complications. The included studies supported the safety and efficacy of these nonsurgical options for the treatment of WTs. Conclusion: Nonsurgical approaches, such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy, have emerged as viable alternatives to surgical intervention for the management of WTs. These interventions offer promising outcomes in terms of tumor size reduction and cosmetic improvement. Further research with larger sample sizes and long-term follow-up is warranted to validate these findings and establish standardized protocols for nonsurgical management of WTs.

Recommendations to minimize tooth root remodeling in patients undergoing maxillary osteotomies.

The purpose of this study was to report root remodeling/resorption percentages of maxillary teeth following the different maxillary osteotomies; i.e. one-piece, two-pieces, three-pieces Le Fort I, surgically assisted rapid palatal expansion (SARPE). The possibility of relationships between root remodeling and various patient- and/or treatment-related factors were further investigated. A total of 110 patients (1075 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The sample size was divided into: 30 patients in one-piece Le Fort I group, 30 patients in multi-pieces Le Fort I group, 20 patients in SARPE group and 30 patients in orthodontic group. Preoperative and 1 year postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and automated method for evaluating root remodeling and resorption in three dimensions (3D) was applied. SARPE group showed the highest percentage of root remodeling. Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement contributing to more root remodeling. On the other hand, the orthodontic group showed a negative correlation with age indicating increased root remodeling in younger patients. Based on the reported results of linear, volumetric and morphological changes of the root after 1 year, clinical recommendations were provided in the form of decision tree flowchart and tables. These recommendations can serve as a valuable resource for surgeons in estimating and managing root remodeling and resorption associated with different maxillary surgical techniques.

Factors Associated With Postoperative Complications in Patients Who Underwent Parotidectomy: A Retrospective Study.

Objectives: This study aimed to determine the prevalence of complications after parotidectomy and identify factors associated with these complications. Methods: Data from patients who underwent parotidectomy for neoplasms in 2 tertiary centers were analyzed. Patient characteristics and postoperative complications were collected. Demographics, diabetes, and smoking status were evaluated using descriptive statistics. The prevalence of complications was determined and associations with smoking, surgical type, preoperative facial nerve involvement, final pathology, and Milan category were examined using chi-squared and correlation analyses. Results: Majority of patients were male (59.5%), falling within the age range of 31 to 50 years (42.7%). The most common complication was facial nerve weakness (23.6%), followed by seroma (19.1%), ear numbness (17.3%), and tumor recurrence (8.7%). Xerostomia demonstrated a correlation with smoking, while more invasive types of surgery showed associations with surgical site infection and tumor recurrence. Malignant disease on the final pathology and higher Milan category exhibited links with salivary fistula. No clear associations were found between preoperative facial nerve involvement and any of the complications. Age and body mass index (BMI) did not demonstrate significant correlations with complications. Conclusions: This study highlights the prevalence and associations of postparotidectomy complication. Facial nerve weakness was the most common followed by seroma and ear numbness. Smoking was correlated with xerostomia, while more invasive type of surgery was correlated with infection and recurrence. Age and BMI did not have associations. Personalized approaches and understanding factors for effective management are important. Further research is recommended to validate the outcome and understand the recovery from parotidectomy.

Measurement of the lengths of different sections of the upper airway and their predictive factors.

BACKGROUND: No studies have been conducted to define the lengths of the upper airway's different segments in normal healthy adults. AIMS/OBJECTIVES: This study aimed to determine the length of the subglottis and extrathoracic trachea and the factors affecting it. MATERIAL AND METHODS: This was an observational retrospective review study. Included 102 adult patients who underwent CT scan during the quiet inspiration phase of the upper airway. RESULTS: The results revealed significant positive linear relationships between height and both anterior and posterior subglottic measurements (p < 0.001). Additionally, a statistically significant, moderately strong negative correlation between age and extrathoracic tracheal measurements (p > 0.001) was observed. Men exhibited longer anterior (p < 0.001) and posterior (p > 0.001) subglottic measurements. In both sexes, the average length of the anterior subglottis was 14.16 (standard deviation [SD]: 2.72) mm, posterior subglottis was 14.51 (SD: 2.85) mm and extrathoracic trachea was 66.37 (SD: 13.71) mm. CONCLUSION AND SIGNIFICANCE: We concluded that a normal healthy adult's anterior subglottis length is 6.3-19.3 mm (mean: 14.16 [SD: 2.72] mm), posterior subglottis length is 6.1-20.0 mm (mean: 14.51 [SD: 2.85] mm) and extrathoracic trachea length is 25.2-98.5 mm (mean: 66.37 [SD: 13.71] mm). Age, height and sex affected the upper airway length.

Papillary thyroid microcarcinoma with and without nodal metastasis: A comparative analysis.

OBJECTIVES: To assess the demographics and clinical factors of papillary thyroid microcarcinoma (PTMC) patients in Saudi Arabia and compared and analyzed the differences between the patients with and without lymph node metastasis (LNM). Papillary thyroid microcarcinoma (PTMC) is a common thyroid cancer and is not usually detectable clinically but found incidentally after pathologic evaluation of thyroid tissue following surgery for benign thyroid disorders. However, these tumors have a significant risk of LNM. METHODS: All PTMC patients who underwent surgery at King Abdulaziz University Hospital, King Fahad Medical City, and King Abdulaziz Medical City from 2012 to 2022 were included. The incidence rate of LNM was 9.17%. The patients' average age was 44.05. Most of the patients were female. RESULTS: Prevalence of LNM among PTMC patients is 9.17% (n=31). The PTMC patients showed the following significant risk factors for LNM: higher Bethesda class, type of pathology, extrathyroidal extension, extracapsular extension, lymphovascular invasion, and residual tumors in patients who had received radioactive iodine. Presence of thyroiditis, multifocality, goitrous thyroid, neural invasion, and tumor size were unrelated to the LNM in the PTMC patients. CONCLUSION: Higher Bethesda class, pathology type, extrathyroidal extension, extracapsular extension, lymphovascular invasion, and RAI-treated residual tumors were strongly linked to LNM.

Burnout Syndrome Among Critical Care Health Providers in Saudi Arabia.

Background: Burnout Syndrome constitutes a critical concern in healthcare, particularly among practitioners operating in high-stress, critical care settings. Understanding the multifaceted factors contributing to burnout in this context is pivotal for devising effective interventions and promoting the well-being of critical care professionals. Objective: To investigate the prevalence, contributing factors, and potential interventions related to Burnout Syndrome among critical care health providers in Saudi Arabia. Methods: A cross-sectional research design was employed, gathering data from a sample of critical care health providers, including medical practitioners. A self-administered structured electronic questionnaire was used, incorporating the Maslach Burnout Inventory (MBI) with its three subscales: emotional exhaustion, depersonalization, and personal accomplishment. The target population was male and female critical care health providers over 18 years age, most participants lies between 25 years to 34 years. Results: Statistical analysis shows significant disparities in response distribution (p<0.05), highlighting the importance of understanding encounters with emotional exhaustion, personal accomplishment, and depersonalization. The Durbin-Watson statistic indicated limited autocorrelation, and collinearity tolerance values suggested nominal intercorrelations among predictors. A significant positive correlation was found between the "Depersonalization Loss of Empathy MBI" factor and the outcome variables, indicating complex relationships between emotional exhaustion, personal accomplishment, and depersonalization. Conclusion: The study highlights the multifaceted nature of burnout, revealing intricate relationships between emotional exhaustion, personal accomplishment, and depersonalization. These findings collectively form an important foundation for future guidelines and interventions to enhance the well-being of healthcare professionals.

Retraction: Colonic Gallstone Ileus: A Rare Etiology of Large Bowel Obstruction.

[This retracts the article DOI: 10.7759/cureus.20338.].

"Familial Multiple Coagulation Factor Deficiencies of FXI and FXII in an Asymptomatic Saudi Woman".

Factor XI deficiency (FXI) is the third most common coagulation factor deficiency after hemophilia A and B, ie, in the hierarchy after factors VIII and IX, taking into account von Willebrand's factor deficiency, as bleeding disorders are higher than in hemophilia C. Factor XII deficiency (FXII) is a congenital condition, inherited in the vast majority of cases in an autosomal recessive manner, more often associated with thromboembolic complications. A combination of both factor deficiencies has been found very rarely, and it can be familial multiple coagulation factor deficiency (FMCFD). This study reports the case of a 39-year-old woman from Saudi Arabia who had the combination of FXI and FXII deficiencies, known to be on treatment for hypothyroidism and was referred to a hematology clinic with an incidental finding of prolonged activated partial thromboplastin time (aPTT). Although there was no history of bleeding tendency, her siblings had a family history of an unknown type of bleeding disorder. On physical examination, the patient did not show any bruising, petechiae, or ecchymosis. The aPTT was 69 seconds (27-38) with normal use of other hemostatic agents and was corrected after a 50:50 mixing study. Intrinsic coagulation factors were evaluated, and they revealed severe FXI and moderate FXII deficiencies. Due to a strong family history, the patient was diagnosed with FMCFD. In conclusion, familial combined multiple clotting factor deficiency (FCMFD) is a rare condition that requires attention and reporting. The management strategy in such cases has not been well studied, especially in the long-term symptomatic patient with severe but asymptomatic combined FXI and FXII deficiencies, which is an area for review and further study.

Establishing local diagnostic reference levels for computed tomography examinations using size-specific dose estimates.

OBJECTIVES: To establish local DRL (LDRL) for computed tomography (CT) examinations based on size-specific dose estimates (SSDEs), which consider patient size. The concept of diagnostic reference level (DRL) was introduced to limit patient exposure to unnecessary radiation. However, traditional DRL values do not consider patient size. METHODS: Following institutional committee approval, data were collected from CT examinations of adult patients at Madinah General Hospital, Al Madinah Al Munawwarah, Saudi Arabia from January to March 2023. The SSDE was calculated for each patient using the effective diameter (Deff). RESULTS: The LDRLs of the brain, cervical spine, chest, thoracic spine and kidneys, ureters, and bladder (KUB) examinations were 118 mGy, 12 mGy, 8 mGy, 17 mGy, and 7 mGy, respectively. A strong correlation was observed between SSDEs and the volume computed tomography dose index (CTDIvol) for all examinations except chest scans (p<0.05). Size-specific dose estimates were higher than the CTDIvol, with a greater difference for patients with smaller Deff (p<0.05). CONCLUSION: The established LDRL was within the international DRL. The use of SSDE has the potential to provide more accurate and relevant data for radiation safety practices; however, widespread adoption of SSDE in new CT scanners is necessary for promoting consistency and standardization methodologies.

Deep convolutional neural network-based automated segmentation and classification of teeth with orthodontic brackets on cone-beam computed-tomographic images: a validation study.

OBJECTIVE: Tooth segmentation and classification from cone-beam computed tomography (CBCT) is a prerequisite for diagnosis and treatment planning in the majority of digital dental workflows. However, an accurate and efficient segmentation of teeth in the presence of metal artefacts still remains a challenge. Therefore, the following study aimed to validate an automated deep convolutional neural network (CNN)-based tool for the segmentation and classification of teeth with orthodontic brackets on CBCT images. METHODS: A total of 215 CBCT scans (1780 teeth) were retrospectively collected, consisting of pre- and post-operative images of the patients who underwent combined orthodontic and orthognathic surgical treatment. All the scans were acquired with NewTom CBCT device. A complete dentition with orthodontic brackets and high-quality images were included. The dataset were randomly divided into three subsets with random allocation of all 32 tooth classes: training set (140 CBCT scans-400 teeth), validation set (35 CBCT scans-100 teeth), and test set (pre-operative: 25, post-operative: 15 = 40 CBCT scans-1280 teeth). A multiclass CNN-based tool was developed and its performance was assessed for automated segmentation and classification of teeth with brackets by comparison with a ground truth. RESULTS: The CNN model took 13.7 ± 1.2 s for the segmentation and classification of all the teeth on a single CBCT image. Overall, the segmentation performance was excellent with a high intersection over union (IoU) of 0.99. Anterior teeth showed a significantly lower IoU (P < 0.05) compared to premolar and molar teeth. The dice similarity coefficient score of anterior (0.99 ± 0.02) and premolar teeth (0.99 ± 0.10) in the pre-operative group was comparable to the post-operative group. The classification of teeth to the correct 32 classes had a high recall rate (99.9%) and precision (99%). CONCLUSIONS: The proposed CNN model outperformed other state-of-the-art algorithms in terms of accuracy and efficiency. It could act as a viable alternative for automatic segmentation and classification of teeth with brackets. CLINICAL SIGNIFICANCE: The proposed method could simplify the existing digital workflows of orthodontics, orthognathic surgery, restorative dentistry, and dental implantology by offering an accurate and efficient automated segmentation approach to clinicians, hence further enhancing the treatment predictability and outcomes.

Automated three-dimensional quantification of external root resorption following combined orthodontic-orthognathic surgical treatment. A validation study.

OBJECTIVE: Three-dimensional (3D) quantitative assessment of external root resorption (ERR) following combined orthodontic-orthognathic surgical treatment is vital for ensuring an optimal long-term tooth prognosis. In this era, lack of evidence exists applying automated 3D approaches for assessing ERR. Therefore, this study aimed to validate a protocol for 3D quantification of ERR on cone-beam computed tomography (CBCT) images following combined orthodontic-orthognathic surgical treatment. MATERIAL AND METHODS: Twenty patients who underwent combined orthodontic-orthognathic surgical treatment were recruited. Each patient had CBCT scans acquired with NewTom VGi evo (NewTom) at three time-points i.e., 4-weeks prior to surgery (T0), 1-week (T1) and 1-year after surgery (T2). Patients were divided into two groups, group A (surgical Le Fort I osteotomy group: 10 patients) and group B (orthodontic group without maxillary surgical intervention: 10 patients). Root resorption was assessed by measuring length and volumetric changes of maxillary premolar to premolar teeth (central and lateral incisors, canines, 1st and 2nd premolars= 10 teeth) at T0-T1 and T0-T2 time intervals in both groups. The protocol consisted of convolutional neural network based segmentation followed by surface-based superimposition and automated 3D analysis. RESULTS: The intra-observer intra-class correlation coefficient (ICC) was found to be excellent (1.0) with an average error of 0 mm and 0 mm3 for assessing root length and volume, respectively. The entire protocol took 56.8 ± 7 s for quantifying ERR. Both group of patients showed negligible changes in length and volumetric ratio at T0-T1 time-interval. Furthermore, group A had lower ERR ratio with decreased root volume and length compared to group B at T0-T2 time-interval. CONCLUSIONS: The proposed protocol was found to be time efficient, accurate and reliable for 3D quantification of ERR on CBCT images. It could act as a viable automated option for assessing ERR. CLINICAL SIGNIFICANCE: The automated protocol could provide a time efficient method to allow a reliable and accurate 3D follow up root resorption after orthognathic and orthodontic treatment procedures. These new insights could allow clinicians to implement strategies for minimizing the risk of root resorption and to further enhance treatment predictability.

The effect of disruption due to COVID-19 on operating room utilization: Experience from a secondary care hospital in Riyadh, Saudi Arabia.

Introduction/Background: The disruption caused due to corona virus disease-2019 (Covid-19) has affected the overall health care delivery worldwide. The elective services were foremost to face the restrictions and closure, subsequently they were resumed only after adoption on newer protocols. Aims: We aimed to estimate the effect of COVID-19 restrictions on operative room utilization. Methodology: This is a retrospective descriptive study. The surgical volume indicators were calculated and a comparison was made between pre-COVID-19 (April-June 2019) and COVID-19 phase (April-June, 2020). Pre-operative covid assessment through the RT-PCR test among the cases waiting for elective surgeries. Results: Overall surgical volume decreased by 53%, which included 87% decrease in elective procedures and 8% decrease in emergency procedures. The overall OR utilization reduced by 63%. Highest reduction in the surgical volume was noted in bariatric surgery (no surgeries conducted in the COVID-19 phase), ophthalmology (99% reduction), and Ear, Nose and Throat surgery (ENT) surgery (92% reduction). Six patients tested positive for pre-operative RT-PCR from the sample of 261 cases posted for elective surgery during resumption phase of elective services, thereby giving the positivity rate of about 2.2%. Conclusion: We found a high level of reduction in the operating room utilization in a secondary care public sector hospital. The pre-operative assessment has enabled to find out the COVID-19 cases and hence preventing the unwanted spread of infection during the surgical procedures.

Perceptions of Parents towards COVID-19 Vaccination in Children, Aseer Region, Southwestern Saudi Arabia.

Vaccines are an important part of the COVID-19 pandemic response plan. This cross-sectional study aims to assess the attitude and perception levels of parents toward COVID-19 vaccines for children aged 0-18 years in the Aseer region of Saudi Arabia. Data were analyzed using SPSS version 16.0. Out of a total of 1463 parents, 30.6% assumed that COVID-19 vaccination may be more dangerous for children than adults. Nearly 36.5% parents don't have any concern about children's vaccination. About 12.8% of children have not received the vaccination, 55% of parents have some sort of hesitation and 32.2% of parents did not hesitate before vaccinating their children against COVID-19. Only 15.4% of parents expect that the COVID-19 vaccine affects their child's genes. About 23.4% parents strongly agreed and 35.1% agreed about the importance of getting their children vaccinated. About 22.1% of parents strongly agreed and 33.3% agreed regarding their willingness to get their children vaccinated to prevent Coronavirus disease. More than 80% of parents recommended rushing to receive the COVID-19 vaccine. Health professionals and policymakers should implement and support strategies to ensure children are vaccinated for COVID-19. They also need to educate parents and families regarding childhood vaccination.

Impact of orthognathic surgery on root resorption: A systematic review.

OBJECTIVE: This systematic review was performed to assess the potential influence of orthognathic surgery on root resorption (RR). MATERIAL AND METHODS: An electronic search was conducted using PubMed, Web of Science, Cochrane Central and Embase for articles published up to April 2022. Following inclusion and exclusion criteria, a total of six articles were selected that reported on RR following orthognathic surgery. Risk of bias assessment was performed according to the ROBINS-1 and ROB-2 tools. RESULTS: The design of five studies was retrospective and one randomized clinical trial was included, with a follow-up period ranging between six months and ten years. The assessment methodologies mostly relied on two-dimensional imaging modalities where only one study used cone-beam computed tomography (CBCT) for objective quantification via linear measurements. The percentage of teeth affected by RR varied between approximately 1 and 36%, where surgically assisted rapid maxillary expansion (SARME) and Le Fort I osteotomy showed the highest percentage of RR followed by bilateral sagittal split osteotomy. CONCLUSIONS: The present data tend to indicate that specific orthognathic procedures such as SARME and Le Fort I osteotomy may induce or reinforce RR. Yet, considering lack of evidence related to objective quantification of RR following orthodontic and/or orthognathic treatment, further CBCT-based prospective studies are required for an improved understanding of RR following different surgical procedures.

Three-dimensional quantification of the relationship between the upper first molar and maxillary sinus.

OBJECTIVES: The present study aims to describe the relationship between upper first molar roots and maxillary sinus, for the first time with a truly three-dimensional approach. METHODS: From a retrospective cone-beam computed tomography (CBCT) sample of the upper jaw, a total of 105 upper first molars in contact with maxillary sinus from 74 patients (male 24, female 50, mean age 42) were included in the present study. Segmentation of the upper first molar and maxillary sinus in CBCT was performed utilizing a semiautomatic livewire segmentation tool in MeVisLab v.3.1. The segmentations were analyzed in 3-matic Medical 20.0 for root volume and the contact area between upper first molar roots and maxillary sinus. Analysis of variance test was applied to detect statistically significant differences between the roots. RESULTS: The palatal root had the largest contact area with maxillary sinus 27.8 ± 21.4 mm2 (20% of the root area) followed by the mesiobuccal 20.5 ± 17.9 mm2 (17% of the root area) and distobuccal root 13.7 ± 12 mm2 (14% of the root area). A significant difference in the contact area of the different roots of the upper first molar was seen. CONCLUSIONS: This study showed that 70% of the upper first molars were in contact with the maxillary sinus. The palatal root had on average a fifth of its root surface in contact with the sinus, while for mesiobuccal this was a sixth of its root surface and distobuccal roots this was somewhat less. The true 3D relationship could help to better understand maxillary anatomy in relation to occurring pathologies and treatment planning in this area.